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Affidavit of Survivorship
I, Steve Roper, being of lawful age and duly sworn according to law, upon my oath,
depose and state:
That under the date of October 25, 1 999, for valuable consideration, Diane P. McDonald,
by deed of that date, which deed was duly filed of record in the Office of the Lincoln County Clerk,
on December 6, 1999, in Book 439PR, Page 092, conveyed to Steve Roper and Diane P.
McDonald, in joint tenancy, the following described land, in the County of Lincoln, State of
Wyoming, to -wit:
Lot 17, Grand View Enterprises, Inc., Tract 1, as shown on the official plat thereof filed with the
County Clerk at Kemmerer, WY.
Subject to restrictions and reservations contained in the United States Patent and to easements
and rights -of -way of record or in use.
Together with all improvements and appurtenances thereon.
That by reason of said conveyance aforesaid, the said Steve Roper and Diane P.
McDonald, in joint tenancy, became the owners of said real property, and the title thereto vested
in them continuously from the date of said conveyance, to the date of death of Diane P.
McDonald, on the nth day of July, 2009. That by reason of and upon the death of Diane P.
McDonald, title in the above described real property had vested in Steve Roper.
Affiant avers and certifies that Diane P. McDonald, is the identical party named with
Steve Roper in the aforementioned deed, whose death terminated her interest, title and estate in
said real property; and Affiant attaches hereto, and makes a part of this affidavit, a copy of the
Official Certificate of Death of said decedent, duly certified by the public authority in which said
death certificate is a matter of record.
Dated this (-2 day of /d 2012.
State of U 'A \I\
ss.
County of ),Qi
Subscribed and sworn to before me, a notary public in and for said County and State, by
Steve Roper, this 2°1 day of h(DV ern hGf 2012.
WITNESS my hand and official seal.
My Commission Expires: 06
3012015
00809
Steve Roper
Notary Public
HEATHER ROBBINS
NOTARY PUBLIC STATE OF UTAH
COMMISSION #610751
COMM. EXP. 06-30-2015
1
CERTIFICATION OF VITAL RECORD
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DECEDENT INFORMATION
Date of Death: July 11, 2009
City of Death: Willard
Age: 62
Place of Birth: Beloit, Wisconsin
Armed Services:. No
Spouse's Name: Steve Roper
Industry/Business: Aerospace /ATK
Residence: Willard, Utah
Mother's Name: Marion Louise Mendenhall
Facility or Address: 101 South 200 West
INFORMANT INFORMATION
Name: Steve Roper ;a
Mailing Address: 101 South 200 West, Willard, Utah
CERTIFICATE OF DEATH
State File Number: 2009020448
Diane Patti McDonald
'(AKA Diane Patti McDonald Roper)
DISPOSITION INFORMATION
Method of Disposition: Buriet
Place of Disposition: Willard Precinct Cemetery Willard, Utah
Date of Disposition: Juiy 17, 2009,;
FUNERAL HOME INFOR41, iQN
Funeral Home:.C,illies Chapel
Address: 634East200 South, Brigham
Funeral Director: 'Brent :M4Gillies
MEDICAL CERTIFIC4TION
Medical Professional: Van Christensen, 1100 West 2700 North, Pleasant View, Utah 84414
CAUSE OF DEATH
Respiratory Failure [Onset: 1 Day]
Quadriplegia
Tobacco Use: Non-user,,`
Medical Examiner Contacted
Date Issued: July 16,/2009
e
ty, itah'84302
es Autopsy Performed: No >Manner of Death: Natural
This is an exact reproduction of the document registered in the State Office of Vital Statistics.
Security features of this official document include: Intaglio Border, V R images in top cycloids,
ultra violet fibers and hologram image of the Utah' State Seal, over the words "State of Utah This
document displays the date, seal and signature of the State Registrar and the County /District Health Officer.
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11
Time of Death:
County of Death:
Date of Birth:
Sex:
Marital Status:
Usual Occupation:
Education:
Father's Name:
Facility Type:
Relationship:
84340
1
*061427369*
05:30
Box Elder
August 2, 1946
Female
Married
Utility Production Technician
Some College but No Degree
George Malcolm Duncan
Home
SpoUSeT,
Lloyd Berentzen
DirectorMealth Officer
County/District Health Department
00803
Barry E, Nangle, State, Registrar
Office of Vital Statistics
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